4. Introduction
•
The tongue is a complex organ involved in speech and
expression as well as in gustation, mastication, and
deglutition.
• The oral cavity and the tongue are sites of neoplasms,
reactive processes, and infections and may be a
harbinger of systemic diseases
5.
6. Functions of the tongue
• Speech
• Sucking
• Taste
• Digestion
• Maintenance of oral hygiene
7. Glossitis
• Glossitis is the term used for the red, smooth and sore
tongue
• particularly characteristic of anaemia. These features are
a
combination of signs (redness and smoothness) and a
symptoms (soreness) which are not always associated.
8. • Important causes of
glossitis
• Anaemia
• Vitamin B group
(especially B12)
deficiencies
• Candidosis
9. Inx
• Detailed haematological examination is essential.
Treatment
• treatment of specific causes quickly relieves the
symptoms.
10. Vascular and lymphatic lesions
(Infantile hemangiomas)
Infantile hemangiomas (IHs) are benign vascular
neoplasms and are the most common soft tissue
tumors in childhood
They are more prevalent in girls and most commonly
affect the head and neck region
The majority of growth of IHs is seen in the first 2
months of life
11. Clinical features
Although oral IHs are rare relative to the skin, they
represent one of the most common lesions in the oral
cavity of children and often affect the tongue, buccal
mucosa, lips (soft tissue mass, pain, swelling and/or
discoloration)
the clinical differential diagnosis is dependent on the tumor
depth and includes pyogenic granuloma, angiosarcoma,
and other vascular tumors
12.
13. Treatment
• The treatment of IHs is dependent on the risk of
compromise of vital organs and structures as well as
cosmesis.
Oral propranolol is now Food and Drug
Administration approved for IHs and has become the
gold standard for treatment
Response rates for propranolol are 98% with a goal
dose of 2mg/kg/day and 6 months of therapy
14. Oral varices
Oral varices are a common developmental anomaly
noted in older adults.
The etiology of oral varicosities remains unknown.
Although the data are controversial, there may be an
association with old age, smoking, and cardiovascular
disease
15. • Oral varicosities most
commonly involve the ventral
tongue and are characterized
by tortuous, asymptomatic,
compressible veins
16. Oral varices are commonly
seen on the lip, as
venous lakes, but are rare on
the buccal mucosa.
Treatment
is not necessary; however,
conservative excision of
cosmetically concerning
varices is often effective.
17. HAIRY TONGUE
• The filiform papillae which are the cone-shaped structures
that don't contain taste buds, so have no taste function
• These filiform papillae can become elongated and hair-
like forming a thick fur on the dorsum of the tongue.
• The filaments may be up to half a centimetre long and
pale brown to black in colour Adults are affected but the
cause is unknown.
19. Risk factors
• Heavy smoking, excessive use of antiseptic
mouthwashes, and
• defective diet have been blamed, but their effect is
questionable
• Treatment
The measure most likely to succeed is to persuade the
patient to scrape off the hyperplastic papillae and
vigorously cleanse the dorsum of the tongue with a firm
toothbrush.
Surgical removal by electrodessication
20. Fissured tongue
• Fissured tongue (FT) is
a normal variant seen
in up to 20-30% of the
population,
characterized by an
increased number of
fissures and grooves at
the central and lateral
aspects of the tongue
This condition is idiopathic,
more common
in older individuals, and
thought to be a reactive
process
FT is the most common
tongue finding, seen in up to
one third of patients with
psoriasis
21.
22. • Clinically, FT is
characterized by multiple,
asymptomatic 2- to 3-mm
grooves and fissures on the
dorsal surface of the
tongue
There is no effective
treatment for FT;
however, we recommend
good oral hygiene with
brushing deep into the
fissures to remove
debris, lessen the
microbial burden, and
reduce halitosis .
23. Infectious conditions
• Oral hairy leukoplakia
OHL is a corrugated white lesion seen on ventral and
lateral surfaces of the tongue
Commonly associated with HIV
EBV is the causative agent
24. Clinical features
• Lesions are shaggy and
frayed
• Plaque like and often
bilateral
• Microscopy reveals viral
nuclear inclusions
25. Treatment
• No treatment is required usually but….
• Resolves with Zidovudine, Acyclovir, gancyclovir
• Topical application of podophyllin and tretinion
• OHL is highly predictive of AIDS development.
26. Oral candidiasis
Oral candidiasis is most commonly caused by Candida
albicans.
Median rhomboid glossitis is a unique form of candidiasis
that is characterized by large rhomboidal, atrophic
plaques on the posterior-central tongue anterior .
The surface of the tongue may be lobulated or smooth,
and the lesions .
27. Clinical presentation
• are always anterior to the
circumvallate papillae
• The plaques are often
asymptomatic
• Treatment with topical or oral
antifungals is effective.
28. Pernitious anemia
• Chronic hematologic disease
• Caused by lack of intrinsic factor used for gastric
sectretions
• Triad of symptoms
1. Generalized weakness
2. Sore painful tongue
3. Tingling of extremities
30. Malignant neoplasms
(Squamous cell carcinoma)
• SCC is the most common oral malignancy and is a
significant worldwide health issue.
• Oral SCC is more common in men and in those older than
age 40 .
• Extrinsic risk factors include tobacco, alcohol, and sun
exposure (if on the lip).
• Intrinsic risk factors include immunosuppression,
longstanding
inflammation, LP, HPV infection, HIV infection, and
nutritional deficiencies
31.
32. clinical presentation
• The clinical presentation of oral SCCs is highly
variable; therefore, one should maintain a high index
of suspicion , perform a biopsy early in the disease
course, and perform repeat biopsies in refractory oral
inflammatory diseases
• Clues to the diagnosis include longstanding lesions,
irregular and ulcerated papules, nodules, and plaques
that extend above the normal epithelium
33. • The most common sites are the posterior lateral and
ventral surface of the tongue.
• The floor of the mouth is the second most common
location, whereas SCC of the dorsal surface of the tongue
is rare.
34. Treatment
• Multimodal therapy with surgical excision, chemotherapy,
• Or
• radiation remains the standard of care. Recurrence is
high in oral SCC; therefore, long-term monitoring is
required
35. Strawberry tongue
• Strawberry tongue is a
term for a tongue that is
swollen and bumpy. It is
not a health condition but
rather a symptom of
another disease.
37. symptoms
• Strawberry tongue typically presents with the following
symptoms
Tongue rash
Swollen tongue
Increased tongue size
Small bumps on the tongue that look like strawberry
seeds
Redness on the tongue
38. Treatment
• How to treat strawberry tongue depends on the cause
Antibiotics (for bacterial infections)
IV immune globulin and aspirin (for Kawasaki disease)
IV fluids
Pain relievers and fever reducers (for yellow fever)9
Antihistamines (for allergies)
• Typically, the symptoms will also disappear when the
condition causing strawberry tongue resolves.
